Kids’ Access to Primary Care Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 6159 To amend title XIX of the Social Security Act to renew the application of the Medicare payment rate floor to primary care services furnished under the Medicaid program, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MARCH 9, 2020 Ms. SCHRIER (for herself, Ms. CASTOR of Florida, and Mr. FITZPATRICK) in- troduced the following bill; which was referred to the Committee on En- ergy and Commerce A BILL To amend title XIX of the Social Security Act to renew the application of the Medicare payment rate floor to primary care services furnished under the Medicaid pro- gram, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Kids’ Access to Pri- 4 mary Care Act of 2020’’. 5 VerDate Sep 11 2014 02:56 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6159.IH H6159 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 6159 IH SEC. 2. RENEWAL OF APPLICATION OF MEDICARE PAY- 1 MENT RATE FLOOR TO PRIMARY CARE SERV- 2 ICES FURNISHED UNDER MEDICAID AND IN- 3 CLUSION OF ADDITIONAL PROVIDERS. 4 (a) RENEWAL OF PAYMENT FLOOR; ADDITIONAL 5 PROVIDERS.— 6 (1) IN GENERAL.—Section 1902(a)(13) of the 7 Social Security Act (42 U.S.C. 1396a(a)(13)) is 8 amended by striking subparagraph (C) and inserting 9 the following: 10 ‘‘(C) payment for primary care services (as 11 defined in subsection (jj)) at a rate that is not 12 less than 100 percent of the payment rate that 13 applies to such services and physician under 14 part B of title XVIII (or, if greater, the pay- 15 ment rate that would be applicable under such 16 part if the conversion factor under section 17 1848(d) for the year involved were the conver- 18 sion factor under such section for 2009), and 19 that is not less than the rate that would other- 20 wise apply to such services under this title if 21 the rate were determined without regard to this 22 subparagraph, and that are— 23 ‘‘(i) furnished in 2013 and 2014, by a 24 physician with a primary specialty designa- 25 VerDate Sep 11 2014 02:56 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6159.IH H6159 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 6159 IH tion of family medicine, general internal 1 medicine, or pediatric medicine; or 2 ‘‘(ii) furnished during the period be- 3 ginning on the first day of the first month 4 beginning after the date of the enactment 5 of the Kids’ Access to Primary Care Act of 6 2020— 7 ‘‘(I) by a physician with a pri- 8 mary specialty designation of family 9 medicine, general internal medicine, 10 pediatric medicine, or obstetrics and 11 gynecology, but only if the physician 12 self-attests that the physician is 13 board-certified in family medicine, 14 general internal medicine, pediatric 15 medicine, or obstetrics and gyne- 16 cology, respectively; 17 ‘‘(II) by a physician with a pri- 18 mary specialty designation of a family 19 medicine subspecialty, an internal 20 medicine subspecialty, a pediatric sub- 21 specialty, or a subspecialty of obstet- 22 rics and gynecology, without regard to 23 the board that offers the designation 24 for such a subspecialty, but only if the 25 VerDate Sep 11 2014 02:56 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6159.IH H6159 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 6159 IH physician self-attests that the physi- 1 cian is board-certified in such a sub- 2 specialty; 3 ‘‘(III) by an advanced practice 4 clinician, as defined by the Secretary, 5 that works under the supervision of— 6 ‘‘(aa) a physician described 7 in subclause (I) or (II); or 8 ‘‘(bb) a nurse practitioner or 9 a physician assistant (as such 10 terms are defined in section 11 1861(aa)(5)(A)) who is working 12 in accordance with State law, or 13 a certified nurse-midwife (as de- 14 fined in section 1861(gg)(2)) who 15 is working in accordance with 16 State law; 17 ‘‘(IV) by a rural health clinic, 18 Federally-qualified health center, or 19 other health clinic that receives reim- 20 bursement on a fee schedule applica- 21 ble to a physician described in sub- 22 clause (I) or (II), an advanced prac- 23 tice clinician described in subclause 24 (III), or a nurse practitioner, physi- 25 VerDate Sep 11 2014 02:56 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6159.IH H6159 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 6159 IH cian assistant, or certified nurse-mid- 1 wife described in subclause (III)(bb), 2 for services furnished by— 3 ‘‘(aa) such a physician, 4 nurse practitioner, physician as- 5 sistant, or certified nurse-mid- 6 wife, respectively; or 7 ‘‘(bb) an advanced practice 8 clinician supervised by such a 9 physician, nurse practitioner, 10 physician assistant, or certified 11 nurse-midwife; or 12 ‘‘(V) by a nurse practitioner, 13 physician assistant, or certified nurse- 14 midwife described in subclause 15 (III)(bb), in accordance with proce- 16 dures that ensure that the portion of 17 the payment for such services that the 18 nurse practitioner, physician assist- 19 ant, or certified nurse-midwife is paid 20 is not less than the amount that the 21 nurse practitioner, physician assist- 22 ant, or certified nurse-midwife would 23 be paid if the services were provided 24 under part B of title XVIII;’’. 25 VerDate Sep 11 2014 02:56 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6159.IH H6159 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 6159 IH (2) CONFORMING AMENDMENTS.—Section 1 1905(dd) of the Social Security Act (42 U.S.C. 2 1396d(dd)) is amended— 3 (A) by striking ‘‘Notwithstanding’’ and in- 4 serting the following: 5 ‘‘(1) IN GENERAL.—Notwithstanding’’; 6 (B) by inserting ‘‘or furnished during the 7 additional period specified in paragraph (2),’’ 8 after ‘‘2015,’’; and 9 (C) by adding at the end the following: 10 ‘‘(2) ADDITIONAL PERIOD.—For purposes of 11 paragraph (1), the additional period specified in this 12 paragraph is the period beginning on the first day 13 of the first month beginning after the date of the en- 14 actment of the Kids’ Access to Primary Care Act of 15 2020.’’. 16 (b) IMPROVED TARGETING OF PRIMARY CARE.— 17 (1) IN GENERAL.—Section 1902(jj) of the So- 18 cial Security Act (42 U.S.C. 1396a(jj)) is amend- 19 ed— 20 (A) by redesignating paragraphs (1) and 21 (2) as subparagraphs (A) and (B), respectively, 22 and moving the margin of each such subpara- 23 graph, as so redesignated, 2 ems to the right; 24 VerDate Sep 11 2014 02:56 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H6159.IH H6159 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 6159 IH (B) by striking ‘‘For purposes of’’ and in- 1 serting the following: 2 ‘‘(1) IN GENERAL.—For purposes of’’; and 3 (C) by adding at the end the following: 4 ‘‘(2) EXCLUSIONS.—Such term does not include 5 any services described in subparagraph (A) or (B) of 6 paragraph (1) if such services are provided in an 7 emergency department of a hospital.’’. 8 (2) EFFECTIVE DATE.—The amendments made 9 by paragraph (1) shall apply with respect to primary 10 care services provided on or after the first day of the 11 period described in subparagraph (C)(ii) of section 12 1902(a)(13) of the Social Security Act (42 U.S.C. 13 1396a(a)(13)), as amended by section 2. 14 (c) ENSURING PAYMENT BY MANAGED CARE ENTI- 15 TIES.— 16 (1) IN GENERAL.—Section 1903(m)(2)(A) of 17 the Social Security Act (42 U.S.C. 1396b(m)(2)(A)) 18 is amended— 19 (A) in clause (xii), by striking ‘‘and’’ after 20 the semicolon; 21 (B) in clause (xiii)— 22 (i) by moving the margin of such 23 clause 2 ems to the left; and 24 VerDate Sep 11 2014 02:56 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H6159.IH H6159 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 6159 IH (ii) by striking the period at the end 1 and inserting ‘‘; and’’; and 2 (C) by inserting after clause (xiii) the fol- 3 lowing: 4 ‘‘(xiv) such contract provides that (I) payments 5 to health care providers specified in section 6 1902(a)(13)(C) for furnishing primary care services 7 defined in section 1902(jj) during a year or period 8 specified in section 1902(a)(13)(C) are at least equal 9 to the amounts set forth and required by the Sec- 10 retary by regulation, (II) the entity shall, upon re- 11 quest, provide documentation to the State that is 12 sufficient to enable the State and the Secretary to 13 ensure compliance with subclause (I), and (III) the 14 Secretary shall approve payments described in sub- 15 clause (I) that are furnished through an agreed- 16 upon capitation, partial capitation, or other value- 17 based payment arrangement if the agreed-upon capi- 18 tation, partial capitation, or other value-based pay- 19 ment arrangement is based on a reasonable method- 20 ology and the entity provides documentation to the 21 State that is sufficient to enable the State and the 22 Secretary to ensure compliance with subclause (I).’’. 23 (2) CONFORMING AMENDMENT.—Section 24 1932(f) of the Social Security Act (42 U.S.C. 25 VerDate Sep 11 2014 02:56 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H6159.IH H6159 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 6159 IH 1396u–2(f)) is amended by inserting ‘‘and clause 1 (xiv) of section 1903(m)(2)(A)’’ before the period. 2 (3) EFFECTIVE DATE.—The amendments made 3 by this subsection shall apply with respect to con- 4 tracts entered into on or after the date of the enact- 5 ment of this Act. 6 SEC. 3. STUDY. 7 (a) IN GENERAL.—Not later than the date that is 8 one year and one month after the date of the enactment 9 of this Act, the Secretary of Health and Human Services 10 shall conduct a study— 11 (1) comparing the number of children enrolled 12 in a State plan under title XIX of the Social Secu- 13 rity Act (42 U.S.C. 1396 et seq.) (or a waiver of 14 such plan) during the 12-month period preceding the 15 first day of the period described in subparagraph 16 (C)(ii) of section 1902(a)(13) of such Act (42 17 U.S.C. 1396a(a)(13)), as amended by section 2, to 18 the number of children so enrolled during the 12- 19 month period beginning on such first day; 20 (2) comparing the number of health care pro- 21 viders receiving payments for primary care services 22 under the Medicaid program under such title during 23 the 12-month period preceding the first day of the 24 period described in subparagraph (C)(ii) of section 25 VerDate Sep 11 2014 02:56 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H6159.IH H6159 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 6159 IH 1902(a)(13) of such Act (42 U.S.C. 1396a(a)(13)), 1 as amended by section 2, to the number of health 2 care providers receiving such payments during the 3 12-month period beginning on such first day; and 4 (3) comparing health care provider payment 5 rates for primary care services under the Medicaid 6 program under such title during the 12-month pe- 7 riod beginning on the first day of the period de- 8 scribed in subparagraph (C)(ii) of section 9 1902(a)(13) of such Act (42 U.S.C. 1396a(a)(13)), 10 as amended by section 2, across States, using the in- 11 dexes described in subsection (b). 12 (b) INDEXES DESCRIBED.—The indexes described in 13 this subsection are each of the following: 14 (1) A Medicaid fee index, comparing each 15 State’s average fee for primary care services under 16 the Medicaid program under such title to the na- 17 tional average for such services. 18 (2) A Medicaid-to-Medicare fee index, com- 19 paring each State’s average fee for primary care 20 services under the Medicaid program under such 21 title to the fee for such services under the Medicare 22 program under title XVIII of such Act (42 U.S.C. 23 1395 et seq.). 24 VerDate Sep 11 2014 02:56 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H6159.IH H6159 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 6159 IH (3) A Medicaid fee change index, comparing 1 fees for primary care services under the Medicaid 2 program under such title during the 12-month pe- 3 riod preceding the first day of the period described 4 in subparagraph (C)(ii) of section 1902(a)(13) of 5 such Act (42 U.S.C. 1396a(a)(13)), as amended by 6 section 2, to the fees for such services during the 7 12-month period beginning on such first day. 8 (c) AUTHORIZATION OF APPROPRIATIONS.—For pur- 9 poses of this section, there is authorized to be appro- 10 priated $200,000 for fiscal year 2021, to be available until 11 expended. 12 SEC. 4. SENSE OF CONGRESS REGARDING USE OF BRIGHT 13 FUTURES GUIDELINES. 14 It is the sense of Congress that health care providers 15 should provide early and periodic screening, diagnostic, 16 and treatment services (as defined in section 1905(r) of 17 the Social Security Act (42 U.S.C. 1396d(r)) in accord- 18 ance with the guidelines of the American Academy of Pe- 19 diatrics entitled, ‘‘Bright Futures: Guidelines for Health 20 Supervision of Infants, Children, and Adolescents’’. 21 Æ VerDate Sep 11 2014 02:56 Mar 14, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\H6159.IH H6159 kjohnson on DSK79L0C42PROD with BILLS